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Category: Venous Thromboembolism

Bolus Thrombolysis in Venous Thromboembolism (28)

The efficacy and safety of rt-PA administered as an accelerated regimen or a true bolus infusion have been evaluated both in patients with acute myocardial infarction and in patients with pulmonary embolism. Levine and coworkers carried out a double-blind randomized study in which patients with acute symptomatic pulmonary embolism who were receiving heparin were allocated…

Bolus Thrombolysis in Venous Thromboembolism (27)

In addition, regarding the prevention of the postphlebitic syndrome, the results of the few studies presently available are contradictory. Thus, heparin has remained the mainstay of treatment for DVT, mainly because of fear of an unfavorable ratio of efficacy to bleeding side effects with thrombolytic agents. Preliminary clinical experience with rt-PA in patients with DVT…

Bolus Thrombolysis in Venous Thromboembolism (26)

These considerations explain why thrombolysis has not been universally adopted for patients with pulmonary embolism; in many medical centers, lytic therapy is often reserved for patients with massive pulmonary embolism and a significant hemodynamic impairment. Promising results have been obtained with rt-PA in a series of clinical trials reported by Goldhaber et al.

Bolus Thrombolysis in Venous Thromboembolism (25)

Thus, our studies confirmed the efficacy of the rt-PA bolus, but they also showed that the standard therapeutic approach has to be improved. More effective concomitant adjunctive treatment and use of a plasminogen activator with a prolonged half-life appear, at present, to be promising approaches. The definite role of these emerging strategies will depend on…

Bolus Thrombolysis in Venous Thromboembolism (24)

Results The results of the study are shown in Figure 8. Three hours after rt-PA bolus, 56 ± 7 |xg of radioactive fibrin had accreted on the thrombi. This amount was reduced to 24 ± 3 |xg 3 h after a bolus of K2tu-PA. The difference between rt-PA and Kgtu-PA was statistically significant (p<0.01). These…

Bolus Thrombolysis in Venous Thromboembolism (23)

Study of Thrombolytic Effects of Bolus Injection of a Plasminogen Activator with Prolonged Half-life. The short half-life of rt-PA might be a possible limitation for its bolus administration due to its inability to prevent the accretion of new fibrin on the thrombi and thus thrombus extension. In recent years, several forms of mutants and hybrids…

Bolus Thrombolysis in Venous Thromboembolism (22)

Discussion Our study showed the efficacy of hirudin in inhibiting thrombus extension after rt-PA bolus. These results are consistent with the role of thrombin activity in thrombus extension after rt-PA. It has been shown that thrombolytic therapy is associated with thrombin generation, which could contribute to rethrombosis. Indeed, the activation of blood coagulation during thrombolytic…

Bolus Thrombolysis in Venous Thromboembolism (21)

Experimental Procedure Thrombus extension was evaluated as previously described in this article. A bolus of rt-PA, 0.4 mg/kg, was injected over 2 min. Heparin, 0.75 mg/kg, and r-hirudin (CGP 39393, Ciba-Geigy), 1.25 mg/kg, were infused over 3 h. Infusion of heparin and r-hirudin started immediately after the rt-PA bolus. The doses of heparin and hirudin…

Bolus Thrombolysis in Venous Thromboembolism (20)

Hirudin is a potent and highly specific thrombin inhibitor able to prevent thrombus growth in rabbits when given in combination with a prolonged infusion of rt-PA. The biologic rationale for the pharmacologic efficacy of hirudin is provided by recent achievements in the basic knowledge of the process of thrombus extension during and after thrombolysis.

Bolus Thrombolysis in Venous Thromboembolism (19)

Results The results are shown in Table 1 and Figures 4, 5, and 6. Increasing doses of heparin did not influence the lysis of fibrin in either saline- or rt-PA-treated rabbits. Heparin efficiently inhibited thrombus growth in saline-treated rabbits. This effect was found only with high doses of heparin in rt-PA-treated rabbits. Thrombus weight values…

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